BEUDAMED
    FDA Adverse Event Other Summary report: N

    CENTURION

    MDR report key: 328026 · Received April 19, 2001

    Report

    Report Number
    1824619-2001-00003
    Event Type
    Other
    Date Received
    April 19, 2001
    Date of Event
    March 2, 2001
    Report Date
    April 17, 2001
    Manufacturer
    TRI-STATE HOSPITAL SUPPLY CORP.
    Product Code
    FOS
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    OH, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    #3.5 FRENCH UMBILICAL VESSEL CATHETER BROKE DURING REMOVAL. THE REMAINING PORTION (APPROXIMATELY 9CM) WAS SURGICALLY REMOVED WITH NO APPARENT ADVERSE CONSEQUENCES.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    18002 CENTURION UMBILICAL VESSEL CATHETER 3.5 FR FOS TRI-STATE HOSPITAL SUPPLY CORP. UVC3594A 12110

    Patients

    Seq Age Sex Outcome Treatment
    1 12 DAY Other